Therapy
insight—New
research suggests that
prolonged exposure
therapy, a form of
psychotherapy that is
widely used in VA as a
firstline treatment for
posttraumatic stress
disorder, may be just
as effective even when
patients have mild to
moderate traumatic
brain injury, along with
PTSD. (Photo by Jon Bradley)

In a small pilot study at the Tampa and Minneapolis VA medical centers, Veterans with posttraumatic stress disorder plus mild to moderate traumatic brain injury showed substantial benefit from prolonged exposure therapy. The treatment is one of two types of psychotherapy used widely in VA to treat PTSD, but some clinicians have been reluctant to use it for PTSD patients who also have TBI. One concern is that these Veterans may be less able to tolerate the distress associated with exposure therapy, in which patients emotionally relive their traumas in a safe, controlled manner. Another concern is that the patients' cognitive limitations might render the therapy less effective. But in the study, which involved 10 Veterans, the therapy was "highly effective in reducing the symptoms of PTSD," write the authors. They note that only a few modifications were needed—such as the use of electronic calendars and smartphones as memory aids, and additional session time or follow-up phone calls. But the authors say these changes are helpful even for those with PTSD but no history of TBI, as these patients often experience anxiety and tenseness that can make them distractible and forgetful. (Journal of Head Trauma Rehabilitation, January 2012)